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Information Form
(Please enter information in all fields or N/A to indicate not applicable.)

Horse Information:

Common Name:

Age:      Color:       Breed: 

Sex:  Male Female     Size:       Reg/Tattoo No.:

Vices: (list all, along with methods of correction/control or if none, enter N/A)

Infirmities
(include known illnesses, allergies, etc.) (list all, along with any medications, etc. given/applied or N/A)

Test/Vaccination Dates:
Negative Coggins Test       West Nile: 

Rabies:       Eastern/Western enceph.: 

"Home" Veterinarian:
 Name                                                     Address:                                                  Phone:  
          

"Local" Veterinarian:
 Name                                                     Address:                                                  Phone:  
          
(Names of local veterinarians will be posted in the barn, if you need one and do not have one.)

Owner Information:
Name:       Local Phone Number:

Local Address:        

Permanent Address: 

Person(s), other than owner, permitted to "handle" horse or N/A :  

Are you bringing a stud or mare in season:  Yes No
List any special arrangements that will be needed for this horse or N/A:

Email Address:      Confirm Email Address: 

Comments:

**Note:  All owners are responsible for providing food for their horses .

    

 

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